Effect of multiple patient reminders in improving diabetic retinopathy screening - A randomized trial

OBJECTIVE - To determine whether multiple mailed patient reminders can prod uce an increase in the rate of diabetic retinal examinations (DRE) over tha t seen with a single reminder. RESEARCH DESIGN AND METHODS - All diabetic members greater than or equal to 18 years who were enrolled in a large network-based health maintenance org anization (HMO) in California from August 1996 to July 1997 were identified using claims and pharmacy databases. Members who had no record of DRE in t he HMO's claims database were then randomized into two groups. Both groups received mailed educational materials and a reminder to obtain the examinat ion Their physician groups also received a letter explaining the program, c urrent guidelines for DRE, and a list of their diabetes patients with their DRE status. The single intervention group received no additional reminders . The multiple intervention group received additional reminders at 3, 6, an d 9 months after baseline if they continued with no record of service, as d etermined from the claims database. RESULTS - The study cohort comprised 19,523 diabetic members, which were ra ndomized into single (n = 9,614) and multiple (n = 9,909) intervention grou ps. There was an increase in monthly DRE rates after the intervention in Au gust 1996 for both intervention groups. After the second reminder was sent to the multiple intervention group, the percentage of diabetic members rece iving DRE was higher than the single intervention group. Rates before and a fter the third intervention were not significantly different, nor were mont hly differences found. There was a significant difference in overall annual DRE rates between the groups (P = 0.023). CONCLUSIONS - Multiple patient reminders are more effective than single rem inders in improving DRE rates in a managed care setting, However, the impro vement noted was clinically small and appeared only after the second remind er; no incremental improvement was seen with additional reminders. Resource s used for multiple reminders aimed at diabetic retinopathy might better be spent on other approaches to reducing complications of diabetes.